Resectoscope



Sept. 22, 1964 F. G. zlNGALE RESECTOSCOPE 2 Sheets-Sheet 1 Filed June 151961 Sept 22 l964 F. G. ZINGALE 3,149,633

REsEcToscoPE Filed June l5 1961 2 Sheets-Sheet 2 1. y. Wsa

United States Patent 3,149,633 RESECTOSCOPE Frank G. Zingale, 9762 GldWarsou Road, St. Louis, Mo. Filed June 15, 1961, Ser. No. 117,429 7Claims. (Cl. 12S-303.15)

This invention relates to a resectoscope and more particularly to apneumatically operated and easily controlled resectoscope that can beheld and operated with one hand.

The resectoscope includes a body having a reciprocable cutting loop inthe form of a tungsten electrode that is supplied with a high frequencycurrent. There is also a telescope extending through the resectoscope sothat the operator can watch his work, and there is a water tube forapplying fluid to the affected area. All resectoscopes have theseelements.

This resectoscope, however, provides a pneumatic valve controlled powersupply for reciprocating the cutting loop. The valve is operable by thefinger of the hand that supports the body of the resectoscope, so thatboth holding and operating of the resectoscope can be accomplished withone hand.

A prostatic operation using a resectoscope is an ex tremely tediousoperation. The movements of the tungsten cutting loop must be asaccurately controlled as possible, because it is this cutting loop thatsears and cuts away the affected, enlarged, obstructing parts of theprostate. This resectoscope provides a highly sensitive control for themovement of the tungsten cutting loop. It is, therefore, an object ofthe invention to provide a resectoscope having a reciprocable tungstencutting loop with a pneumatic power supply for reciprocating the cuttingloop and a highly sensitive control for transmitting the pneumatic powerinto movement of the cutting loop.

Another very important object of the invention is to provide aresectoscope having a reciprocable tungsten cutting loop with controlmeans for reciprocating the cutting loop that are readily accessible tothe finger of a hand holding the body of the resectoscope. Theimportance of this object will be apparent to those familiar with theart, who recognize the desirability of a resectoscope that caribecompletely operated and controlled by one hand. This leaves the otherhand of the doctor free to manipulate the prostate into position forcutting.

Yet another object of the invention is to provide a resectoscope havinga pneumatic power supply and a control valve therefor with an operatingelementV on the control valve that is movable by the finger of a handholding the resectoscope to control the position of the tungsten cuttingloop at any point between its limits of reciprocating. A particularobject is to provide a resectoscope with a reciprocable cutting loopthat can be halted at any point in its excursions.

Still another object of the invention is to provide a pneumaticallyoperated and controlled surgical instrument having a reciprocableelement, the movement of which is controlled by a valve member operableby a hand holding the instrument, whereinthe instrument may be adaptedto a variety of uses, such as for removal of urinary bladder tumors andthe crushing of urinary bladder stones, and other surgical operativeprocedures involving the unopened urinary bladder.

Still another object of the invention is to provide a resectoscope thatreduces the required time for performing a prostatic operation. Thisreduction in operating time produces a reduction in risk to patients whohave prostatic obstructions. Such patients are usually aged (up toninety-tive years old) and, because of concomitant physical defects, areusually poor anesthetic subjects.

Other objects and advantages will be apparent to those skilled in theart.

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In the drawings:

FIGURE 1 is a plan view, partly in section, of the resectoscope;

FIGURE 2 is a side elevation view, partly in section, of theresectoscope;

FIGURE 3 is a rear elevation View of the resectoscope;

FIGURE 4 is a side elevation view of the rear part of the resectoscopeshowing the side opposite that shown in FIGURE 2;

FIGURE 5 is an enlarged view in section taken along the line 5 5 ofFIGURE 2;

FIGURE 6 is an enlarged side elevation view in longitudinal section ofthe resectoscope;

FIGURE 7 is a view in section taken along the line 7-7 of FIGURE 6;

FIGURE 8 Vis a view in section taken along the line 8--8 of FIGURE 6;

FIGURE 9 is a view in section taken along the line 9-9 of FIGURE 6;

FIGURE 10vis a view in section taken along the line )itl-10 of FIGURE 6showing one position of the control valve;

FIGURE l1 is a View in section similar to the view of FIGURE 9, butshowing the Valve in a different position;

FIGURE 12 is an enlarged view in section showing the connection of theelectrical conductor;

FIGURE 13 is a bottom view of the tungsten cutting loop; andv I FIGURE14 is a side elevation view of a bladder tumor snare that may be usedinstead of the tungsten cutting loop. Y

Referring now to the drawings, .the resectoscope 2G has a hollow moldedplastic body 21 with a generally cylindrical lower side 22 with asomewhat rectangular shaped upper side 23. The. general shape of thebody 21 is illustrated in FIGURES l, 2 and 4, but it should beunderstood that this shape is not especially critical.

At the front end of the upper part 23 of the body 21 there is a recess24. Rearwardly of the recess 24, the body 21 is hollow, as indicated by`the chamber or space 26. A connecting sleeve 27 having a cylindricallyshaped forward portion 28is presstted into the recess 24.

A pair of metal tubes 29 and 30 that are welded, soldered or. otherwisevfixed together, are secured to the inside of the sleeve-27 by a setscrew31 prior to insertion of the sleeve 27 into recess 24. Forward of thesleeve 27, the upper side 32 of the tube 29l is cut oif and the lowerside 33 of the tube 30 is cut off. These tubes 29 and Sil'receivecertain operating parts of the resectoscope as will be explained.

The lower part 22 of thev body 21 has a forward end cap 35 f threadedinto it and a rearward end cap 36 threaded onto it. These forward andrearward end caps are molded onto the ends 37 and 38 of a hollow shaft39. There is another hollow shaft 40 with an end 41 embedded in therearward cap 36, but the hollow shaft 4G extends only about half of thedistance toward the forward cap 35.

A cylindrical slide 41 having end caps 42 and 43 is slidably supportedby the shafts 39 and 40. The end cap 42 has a hole 44`through it and theend cap 43 has two holes 45 and 46 through it. The shaft 39 extendsthrough the holes 44 and 46 and the shaft 4() extends through the hole4S. The end caps 42 and 43 are molded of Teflon or other material thatwill provide a substantial seal with the shafts 39 and 40 while yetproviding a slight amount of air leakage for a purpose to appear.

The slide 41 has a cylindrical side wall 47 that extends 3,1 3 betweenthe end caps 42 and 43. The end caps 42 and 43 are sealed to thecylindrical side wall 47.

A connecting mount 4S is fastened by a pair of screws 49 (or otherconvenient means of attachment) to the top of the slide 41. Thisconnecting mount 48 has an upwardly projecting portion t) with alaterally extending handle 51. As shown in FIGURE 12, the handle S1 isin the form of a hollow plastic sleeve surrounding an electricallyconductive brass terminal 52. The terminal 52 has a threaded end 53 tofasten it securely to the mount 50. The handle passes through alongitudinal slot 54 in the side of the body portion 23.

A tungsten cutting loop 55 is slidably received within the lower tube3i) that extends forwardly of the resectoscope body 21. This cuttingloop 55 is conventional in the resectoscope art. As such, the cuttingloop 55 is electrically conductive and has a bared rearward end 56. Theupper portion 5t? of the connecting mount 48 has a recess 57 in it andthe bared end 56 is pressed into this recess 57 and into electricalcontact with the terminal post 52. The cutting loop shaft is held incontact with the external electrical source by the terminal post whichis threaded and locks the loop in position when tightened. The cuttingloop 55 may be removed from the recess 57 by loosening the terminalpost.

Ari electrical conductor 52 is connected into the hollow handle 51 andestablishes an electrical connection with the bared end 56 of thetungsten cutting loop 55. The cable 58 is connected through a foot pedal59 to a source of high frequency current (not shown) so that upondepression of the foot pedal 59, the forward end 60 of the tungstencutting loop 55 will be heated. As is conventional, this forward end 6uof the cutting loop 55 is bent downwardly.

Conventionally, there is a water tube 65 that extends alongside thetubes 29 and 30; This water pipe extends forwardly to near the cuttingend 60 of the cutting loop 55. Its rearward end is connected to a valve66 and a water supply hose 67 is also connected to the valve 66. Hence,operation of the valve 66 controls the supply of water to the water tube65.

A long telescope 70 is received within the upper tube 29. The forwardend 71 of the telescope 70 is positioned so that a downwardly dependingwide angle lens will cover the excursion distance of the cutting end 69of the cutting loop 55. The body of the telescope passes through 4a hole72 in the body 21 and extends rearwardly of the rear end of the body 21.An eye piece 73 is affixed to the rear end of the telescope. Thistelescope is conventional in the resectoscope art.

The most important aspects to this invention relate to the mechanism foroperating the slide 4S to reciprocate the tungsten cutting loop 55. Asshown in FIGURE 6, there is a cylindrical chamber 76 about Vwhich theend cap 36 is molded. The lower end 77 of this chamber 76 is closed byvirtue of the end cap 36. A threaded cap 73 closes the upper end of thechamber 76.

The chamber 76 has a pair of outlet ports or openings 79 and 80 andthese openings communicate with the interior of the hollow shafts 39 and40, respectively. Connected to the other end of the hollow shaft 40 is apiston member 81.

An O ring 82 surrounds the piston S1 to provide a substantial seal withthe side wall 47 of the slide 41. Thus there are two chambers 83 and 84ori opposite sides of the piston 81.

There is an opening 85 through the hollow tube 39 and in communicationwith the chamber 83. A similar operiing 86 establishes communicationbetween the hollow tube 40 and the chamber 84.

An air hose 90 that is connected to an air compressor (not shown) isalso connected by a threaded fitting 91 into a passage 92 through theend cap 36. This passage `92 terminates at the side wall of the chamber76 and there are two small pin holes 93 and 94 that establishcommunication between the air hose and the interior of the chamber '76.An elongated shaft 96 extends through a hole 97 in the cap 78 at one endof the chamber 76 and into a recess 98 in the end cap 36 at the otherend of the chamber 76. This shaft 96 has an enlarged body portion 99within the chamber 76. An O-ring seal 109 -surrounds the portion 99 ofthe shaft adjacent the two pin holes 93 and 94. Another O-ring seal 101surrounds the portion 99 of the shaft and provides a seal with the sidewall of the chamber 76.

At the upper end of the shaft 96 there is a iinger button 102 andbetween this finger button and the end cap 78 there is a compressionspring 103 that biases the shaft 96 in an upward direction. The extremeupward position of the shaft 96, with the enlarged portion 99 bearingagainst the cap 78 is illustrated in FIGURE 9. In this position of theshaft 96, the O-ring covers the outlet port 8i) while being positionedbetween the two pin holes 93 and 94. Thus, in this position of the 0ringseal 10i), there is air communication from the compressor hose 90through the pin hole 94 to the outlet port 79 and through the hollowshaft 39 and the outlet port 85 into the charnber 83. There is nocompressed air communication into the chamber 84 so the slide 41 isdriven forwardly by the pressure of the compressed air against thepiston 81 and the forward end of the slide. Hence, the normal positiono-f the slide is forward because the compression spring 103 normallyholds the shaft 96 in an upward position. In this normally forwardposition of the slide 41, the tungsten cutting loop 55 is held in aforward position. l

FIGURE ll illustrates an extreme downward position. In this position ofthe shaft 96, the 0-ring seal 100 blocks communication between theoutlet port 79 and either of the inlet pin holes 93 and 94. On the otherhand, both of these pin holes 93 and 94 communicate with the outlet port8i). Therefore, in this lowermost position of the shaft 96 and the Oring seal 160, compressed air is delivered through the outlet port 60and the hollow shaft 40 to the chamber 84 by way of the hole 86 from thehollow shaft 40, and there is no compressed air delivered to the chamber83. Consequently, the slide 41 is driven rearwardly under the pressureof the compressed air against the piston 81 and the rear end 43 of theslide.

T he slide 41 can be modulated between its extreme positions byintermediate movement of the shaft 96. Thus, if the finger button 192 isdepressed less than its maximum amount, the O-ririg seal 199 will movefree of its blocking position as illustrated in FIGURE 9, and the outletport 80 will be exposed to communication with the inlet pin hole 93.However, if the v0-ring seal 109 is not moved far enough, the inlet pinhole 94 will still communicate with the outlet port 79. In this positionof the O-ring seal 109, compressed air is delivered to both the chambers33 and S4. Therefore, the slide 41 will move from its normal forwardmostposition to some inter- ,mediate position or held stationary.

The exact position of the slide can be controlled by the movement orposition of the 'O-ring seal 109 according to whether it completeiy orpartially blocks the outlet port Sti or whether it completely or onlypartially blocks the inlet pin hole 94. It has been found that in actualpractice, the movements of the shaft 96 by a linger depressing fingerbutton 102 produces immediate and accurate response in the position ofthe slide 41.

It has already been mentioned that there is some air leakage allowedthrough the holes 44 and 46 in the end caps 42 and 43 of the slide 41.This leakage is not great, but it is present, so that when one of thechambers S3 or 84 is under the intluence of compressed air and is thenblocked and compressed air is delivered to the other chamber, the aircan escape from the first chamber. This escape of air is not rapid, and,therefore, the slide will not bang back and forth between its extremepositions. In

other words, the slow escape of air provides a cushion for the movementof the slide 41.

A Telion sheath 105 covers the tungsten cutting loop 55, the water tube65, and the telescope '70 forward of the connecting sleeve 27. Thissheath 105, which is not specifically a part of this invention, has apost 106 for drawing it rearwardly over the sleeve mount 27. There is athumb screw locking connection 107 that releasably secures the sheath195 in position.

As is true with other resectoscopes, the sheath 105 has a forward edge109 that cooperates with the tip 60 of the cutting loop 55 to block theescape of the'aifected prostate area during an excursion of the cuttingloop 55.

FIGURE l4 illustrates a urinary bladder tumor snare 119. This snare 110may be substituted for the tungsten cutting loop 55. It has a wire loop111 at its forward end that extends through the body of the carryingtube 111i with an end 112 projecting from the body of the carrying tube.This end 112 is pressed into the recess 57 of the connecting mount Si)while the body of the snare 1119 is held in a fixed position within thetube 31B. Therefore, as the slide 41 is moved rearwardly by operation ofthe finger button 192, the wire loop 111 is drawn toward the body of thesnare to produce the snaring action desired.

Various changes and modifications may be made within the process of thisinvention as will be readily apparent to those skilled in the art. Suchchanges and modifications are within the scope and teaching of thisinvention as defined by the claims appended hereto.

What is claimed is:

l. A resectoscope comprising a body including a control assembly; thecontrol assembly comprising a cylinder member and a piston member in thecylinder, one of said members being mounted in fixed relation withrespect to said body, means for providing relative sliding movementbetween the cylinder and piston members, a cutting loop supported by theother of the members for sliding movement therewith relatively to saidone of Said members, a high frequency current conductor for connectionto a high frequency current source and to the cutting loop to supplycurrent to the cutting loop to heat the cutting loop, means fordelivering high pressure fluid to alternate sides of the piston member,and valve means for controlling the delivery of the fluid, the valvemeans having an operating member supported by the body and positionedfor access by the iinger of a hand holding the body, the operatingmember being movable between first and second positions corresponding tothe extremes of sliding movement of the cutting loop, the valve meanshaving means to regulate the delivery of fluid in response to movementof the operating member to any selected intermediate position'to causethe cutting loop to move to a corresponding intermediate position.

2. The resectoscope of clmm l wherein the operating member is springbiased in one direction and finger operable in the opposite directionand the opposite directions of movement of the operating memberdetermine the side of the piston to which the uid is supplied.

3. In a resectoscope having a cutting loop, a high frequency currentsource, and conductor means connected between the current source and thecutting loop to conduct current to the cutting loop to heat the cuttingloop, the improvement comprising a body defining a fiuid chamber member,a piston member within the chamber member, means for providing relativesliding movement between thev chamber member and piston member, meanssupporting said loop on one of said members for reciprocating movementwith respect to the other member when the chamber member and pistonmember slide relative to one another, the piston member having opposedsides, a first fluid conduit to the chamber adjacent one side of thepiston member, a second fluid conduit to the chamber adjacent theopposite side of the piston member, a valve means for alternativelyopening one fluid conduit and closing the other and for throttling bothconduits in varying relative amounts, the valve means comprising ahousing, the first and second iiuid conduits communicating with thehousing at spaced ports through a side wall of the housing, a fluidsupply conduit connected into the housing, piston means slidable withinthe housing between selected positions, means on said piston means forcommunicating a selective one of the ports with the fluid supply conduitwhen said piston is in one of the selected positions and to intermediatepositions between the last-named positions, the intermediate positionsproviding various areas of communication between the ports and the fluidsupply conduit to provide selective positioning of the cutting loop atany position between its limits of reciprocating movement, and means forsliding the valve member.

`4. The resectoscope of claim 3, wherein the means for sliding the valvemember comprises a shaft connected to the Valve member and extendingthrough the housing, a finger engageable member'connected to the shaft,and a spring for biasing the shaft in a direction away from the housing.

5. The resectoscope of claim 4 wherein the finger engageable member isaccessible to the finger of a hand holding the body of the resectoscope.

6. A resectoscope comprising a body, a piston fixed to the body, acylinder enclosing the piston and slidable relative thereto, a cuttingloop supported by the piston, means for heating the cutting loop, afirst fluid conduit communicating with the interior of the cylinder onone side of the piston, a second fluid conduit communicating with theinterior of the cylinder on the opposite side of the piston, and valvemeans for controlling the flow of fluid through the conduits, the valvemeans comprising a valve chamber with a Valve member slidable therein, apair of outlet ports from the chamber and an inlet port to the chamber,each of the fluid conduits communicating with an outlet port and a fiuidsupply conduit communicating with the inlet port, and a valve memberslidable within the chamber for controlling the communication of theinlet port with the outlet ports, the inlet port comprising at least twotiny openings and the valve member comprising a piston member slidablewithin the chamber while maintaining substantial sealing engagement withthe side wall of the chamber; the tiny openings being sufiiciently closetogether and the outlet ports being sufficiently far apart to allow thepiston member to establish communication with one of the outlet portsand a selective number of the tiny openings according to the position ofthe piston member.

7. The resectoscope of claim 6 wherein the piston member has anoperating shaft connected to it and extending through an end of thechamber, a spring biasing the piston member in one direction, the shaftbeing positioned for depression by a finger of a hand holding theresectoscope body to move the piston member in the other direction.

References Cited in the file of this patent UNITED STATES PATENTS CanadaOct. 2`6, 1948

1. A RESECTOSCOPE COMPRISING A BODY INCLUDING A CONTROL ASSEMBLY; THECONTROL ASSEMBLY COMPRISING A CYLINDER MEMBER AND A PISTON MEMBER IN THECYLINDER, ONE OF SAID MEMBERS BEING MOUNTED IN FIXED RELATION WITHRESPECT TO SAID BODY, MEANS FOR PROVIDING RELATIVE SLIDING MOVEMENTBETWEEN THE CYLINDER AND PISTON MEMBERS, A CUTTING LOOP SUPPORTED BY THEOTHER OF THE MEMBERS FOR SLIDING MOVEMENT THEREWITH RELATIVELY TO SAIDONE OF SAID MEMBERS, A HIGH FREQUENCY CURRENT CONDUCTOR FOR CONNECTIONTO A HIGH FREQUENCY CURRENT SOURCE AND TO THE CUTTING LOOP TO SUPPLYCURRENT TO THE CUTTING LOOP TO HEAT THE CUTTING LOOP, MEANS FORDELIVERING HIGH PRESSURE FLUID TO ALTERNATE SIDES OF THE PISTON MEMBER,AND VALVE MEANS FOR CONTROLLING THE DELIVERY OF THE FLUID, THE VALVEMEANS HAVING AN OPERATING MEMBER SUPPORTED BY THE BODY AND POSITIONEDFOR ACCESS BY THE FINGER OF A HAND HOLDING THE BODY, THE OPERATINGMEMBER BEING MOVABLE BETWEEN FIRST AND SECOND POSITIONS CORRESPONDING TOTHE EXTREMES OF SLIDING MOVEMENT OF THE CUTTING LOOP, THE VALVE MEANSHAVING MEANS TO REGULATE THE DELIVERY OF FLUID IN RESPONSE TO MOVEMENTOF THE OPERATING MEMBER TO ANY SELECTED INTERMEDIATE POSITION TO CAUSETHE CUTTING LOOP TO MOVE TO A CORRESPONDING INTERMEDIATE POSITION.